Open Public Meeting

July 27, 2012 10 am – 12 pm

State Transportation Building, Boston

MassHealth Demonstration to Integrate Care for Dual Eligibles

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Agenda for Today

■ Status Updates

– ICO RFR and Consumer Consultant RFR

– Timeline

– MOU with CMS

■ Project Activities and Implementation

■ Discussion

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Supreme Court Decision on the ACA

■ Landmark ruling on June 28 by the Supreme Court upholding the Patient Protection and Affordable Care Act (ACA)

■ Massachusetts will continue innovating to improve health care, including through the Duals Demonstration, with our federal government partners

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ICO RFR Update

■ RFR issued June 19

■ Respondents Conference held June 25

– Robust attendance

– Q&A spanned wide variety of topics: assessment, provider networks, data, payment, quality, grievances and appeals, enrollment, etc.

■ MassHealth received many questions on the RFR, including those submitted at Respondents’ Conference

■ EOHHS issued a first Q&A document and RFR Amendment #1 on July 24

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Timeline

■ Shifts in some procurement dates in amended RFR

– Deadline for RFR Responses: Aug. 20, 2012

– Anticipated ICO Selection Date: Sept. 21, 2012

■ Contracting and demonstration start dates unchanged:

– Anticipated Contract Execution Date: Dec. 15, 2012

– Anticipated Service Start Date: April 1, 2013

■ Between selection date and contracting will be a Readiness Review period

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■ RFR issued July 5

– To select up to six Consumers (MassHealth members or their immediate family) to form a paid advisory subcommittee

– To review ICO RFR responses and provide input to the procurement team

– Will be facilitated by Assistant Secretary Griffin

■ Responses were due July 20

■ EOHHS now reviewing responses

■ Anticipated selection date: July 30

Consumer Consultant RFR

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■ MassHealth actively working with CMS on the Memorandum of Understanding (MOU)

■ Discussions continue to be productive on all topics, including:

– Terms under which the Demonstration will operate

– Payment rates

– Other issues

■ Will be in place before ICO contracts are signed

MOU with CMS

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Comments or Questions?

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Project Activities and Implementation

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■ Beyond the RFR and MOU processes, there will be important topics and activities to work on

■ These include:

– Outreach and enrollment support

– Training

– Ombudsman

– Implementation advisory committee

– Quality

– Administrative simplification

Implementation Activities

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■ Helping members in the enrollment process

■ How to engage community partners

■ Possible contracted support

■ Outreach to specific population groups

■ Ensuring cultural and language appropriateness

■ Stakeholder role in developing, reviewing and disseminating outreach materials

■ Engaging providers through outreach

Outreach and Enrollment Support

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■ Curriculum development for Learning Collaboratives

■ Consumers as presenters for certain key concepts

■ Mutual exchange between ICOs, providers, consumers, state agencies, and CBOs

Training

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■ Defining the role and scope of activities

■ Options for how to put this in place

Ombudsman

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■ Including members of the disability community

■ Promoting transparency in the implementation of the Demonstration

■ Developing “early warning system”

■ Reviewing input from community partners

■ Reviewing ICO reports on grievances and appeals, early quality and member satisfaction data, etc.

■ Reviewing enrollment policies, procedures, materials, and outcomes

■ Making recommendations to improve services and processes

Implementation Advisory Committee

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■ Methods for collecting data

■ How to use data for policy and implementation decisions

■ How to disseminate information on quality

Quality

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■ Identifying opportunities to streamline administrative processes among providers, ICOs, and MassHealth

Administrative Simplification

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Discussion

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August 31, 2012

10:00 AM – 12:00 PM

One Ashburton Place, 21st Floor

Next Open Meeting

Visit us at www.mass.gov/masshealth/duals

Email us at Duals@state.ma.us